Multiple chronic illnesses increase chance of dementia, study suggests

A study of more than 200,000 Britons linked multimorbidity with an increased risk of dementia. Findings from doctors in the UK and Germany were published this week in the scientific journal JAMA Open Network (The Journal of the American Medical Association).

In general, multimorbidity is when the same individual has multiple chronic diseases. Depending on the concept, it can be considered from two or more diseases.

“It’s that patient you know who has, for example, diabetes, hypertension, asthma”, says neurologist Diogo Haddad, from Hospital Alemão Oswaldo Cruz.

The researchers pooled women and men without dementia and aged at least 60 years to follow up over up to 15 years — the average was 11.8 years. Information from the UK Biobank, a database linked to the British public health system, collected between 2006 and 2010, was used.

In the period, 6,182 participants developed dementia. The incidence rate was 1.87 per 1,000 people without multimorbidity and 3.41 for those with multiple diseases.

Patients with more than one health problem were mostly older women of non-white ethnicity with less education and living in poorer areas of the UK.

“The study proves in a scientifically cohesive way that it is the idea that patients who have several diseases have a higher risk of developing dementia, especially Alzheimer’s, throughout their lives”, analyzes Haddad.

“Based on this, I can say that if you take good care of high blood pressure and diabetes or even prevent these diseases, you are directly preventing the dementia process,” he says.

The research also pointed out that patients without a genetic risk factor, but with comorbidities, have a greater risk of developing dementia than those who do not have multiple chronic diseases.

“Many times people have the idea that dementias and especially Alzheimer’s have a unique and exclusively genetic relationship. In reality, it is not. The disease is multifactorial”, explains the doctor.

Other risk factors

For geriatrics professor Claudia Kimie Suemoto, from FMUSP (Faculty of Medicine, University of São Paulo), the article stands out by showing the most common grouping of diseases that increase risks.

In women it is the association of hypertension, diabetes and coronary heart disease and, in the case of pain, osteoporosis and dyspepsia. In men, the combination of diabetes and hypertension, in addition to the association of coronary heart disease, hypertension and stroke (stroke) are the greatest risk factors.

Maria Gabriela dos Santos Ghilardi, a neurologist at HCor and a doctor in neurology from the department of neurology at FMUSP, recalls that the number of comorbidities is associated with risk: the more chronic diseases, the greater the chance of developing dementia.

According to the doctor, such diseases are always interconnected and it is necessary to have a diagnosis to be able to carry out the treatment and thus prevent other problems arising from them.

Prevention

Neurologist Maria Gabriela dos Santos Ghilardi highlights the indication of prevention as a major conclusion of the study. For the doctor, it has “a greater impact on prevention because through it we can improve the identification of individuals who have a greater risk of developing dementia and, in this way, act in a more effective way to prevent the disease”.

In terms of public health policies, the study points to the treatment of diseases such as diabetes and hypertension as one of the ways to prevent dementia.

“For Alzheimer’s, it is much more important to have quality primary public health than to think about how to bring genetic testing mechanisms”, emphasizes neurologist Diogo Haddad.

“There are factors in the disease: modifiable and non-modifiable. Aging, for example, is not modifiable. On the other hand, hypertension, diabetes, smoking, alcohol are possible factors to control, modify and treat”.